Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Department of Surgery, Division of Surgical Critical Care and Trauma, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Scand J Trauma Resusc Emerg Med. 2018 Dec 17;26(1):107. doi: 10.1186/s13049-018-0572-4.
Damage control strategies play an important role in trauma patient management. One such strategy, hypotensive resuscitation, is being increasingly employed. Although several randomized controlled trials have reported its benefits, the mortality benefit of hypotensive resuscitation has not yet been systematically reviewed.
To conduct a meta-analysis of the efficacy of hypotensive resuscitation in traumatic hemorrhagic shock patients relative to mortality as the primary outcome, with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and multiple organ dysfunction as the secondary outcomes.
PubMed, Medline-Ovid, Scopus, Science Direct, EMBASE, and CNKI database searches were conducted. An additional search of relevant primary literature and review articles was also performed. Randomized controlled trials and cohort studies reporting the mortality rate associated with hypotensive resuscitation or limited fluid resuscitation were selected. The random-effects model was used to estimate mortality and onset of other complications.
Of 2114 studies, 30 were selected for this meta-analysis. A statistically significant decrease in mortality was observed in the hypotensive resuscitation group (risk ratio [RR]: 0.50; 95% confidence interval [CI]: 0.40-0.61). Heterogeneity was observed in the included literature (I: 27%; degrees of freedom: 23; p = 0.11). Less usage of packed red cell transfusions and fluid resuscitations was also demonstrated. No significant difference between groups was observed for AKI; however, a protective effect was observed relative to both multiple organ dysfunction and ARDS.
This meta-analysis revealed significant benefits of hypotensive resuscitation relative to mortality in traumatic hemorrhagic shock patients. It not only reduced the need for blood transfusions and the incidences of ARDS and multiple organ dysfunction, but it caused a non-significant AKI incidence.
损伤控制性策略在创伤患者管理中起着重要作用。其中一种策略，即低血压复苏，正被越来越多地应用。尽管几项随机对照试验已经报道了它的益处，但低血压复苏对死亡率的影响尚未得到系统的评价。
对创伤性失血性休克患者低血压复苏的疗效进行荟萃分析，以死亡率为主要结局，以急性呼吸窘迫综合征（ARDS）、急性肾损伤（AKI）和多器官功能障碍为次要结局。
对 PubMed、Medline-Ovid、Scopus、Science Direct、EMBASE 和中国知网数据库进行了检索。还对相关的原始文献和综述文章进行了额外的搜索。选择了报告低血压复苏或限制液体复苏与死亡率相关的随机对照试验和队列研究。使用随机效应模型来估计死亡率和其他并发症的发生。
在 2114 篇研究中，有 30 篇被纳入本荟萃分析。低血压复苏组的死亡率显著降低（风险比 [RR]：0.50；95%置信区间 [CI]：0.40-0.61）。纳入文献存在异质性（I：27%；自由度：23；p=0.11）。也显示出低血压复苏组的红细胞悬液输注和液体复苏使用量减少。两组之间 AKI 的发生率无显著差异；然而，与多器官功能障碍和 ARDS 相比，低血压复苏显示出保护作用。
本荟萃分析显示，在创伤性失血性休克患者中，与死亡率相比，低血压复苏有显著的益处。它不仅减少了输血的需要，降低了 ARDS 和多器官功能障碍的发生率，而且导致 AKI 的发生率没有显著增加。
